Effect of ankle-foot orthoses on walking efficiency and gait in children with cerebral palsy
Effect of ankle-foot orthoses on walking efficiency and gait in children with cerebral palsy
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DOI：
10.2340/16501977-0209
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发表时间：
2008-07-01
影响因子：
3.5
通讯作者：
Schwartz, Michael
中科院分区：
文献类型：
--
作者：
Brehm, Merel-Anne;Harlaar, Jaap;Schwartz, Michael
目的：以赤足行走为对照，探讨踝足矫形器对异质性脑瘫患儿行走效率和步态的影响。设计：回顾性研究。方法：对172例痉挛性脑瘫患儿（平均年龄9岁，偏瘫21岁，双瘫97岁，四肢瘫54岁）的赤脚矫形和踝足矫形资料进行比较。这些数据包括无量纲速度、步行的净无量纲能量成本（NN-cost）和NN-cost占速度匹配控制的百分比（NN-cost(pct)）。对其中80名儿童进行了吉列步态指数和三维步态运动学和动力学数据分析。结果：使用踝足矫形器行走时，速度提高9% (p < 0.001)，神经网络成本降低6% (p=0.007)，神经网络成本（pct）降低9% （p=0.022）。吉列步态指数保持不变（p=0.607）。累及模式的次级亚组分析显示，神经网络成本（pct）仅在四肢瘫痪患者中有显著改善（20%,p=0.004），而在偏瘫和双瘫患者中保持不变。站立阶段最小膝关节屈曲角和终摆阶段最小膝关节屈曲角的变化与神经网络成本（pct）的变化显著相关（p=0.013和p=0.022）。结论：与光脚行走相比，使用踝足矫形器可显著降低四肢瘫痪脑瘫儿童行走的能量消耗，而在疝瘫和双瘫脑瘫儿童中则保持不变。能源成本的降低与更快和更有效的步行方式有关。效率的提高反映在姿态和摆动阶段膝关节运动的变化上，即膝关节屈曲角度向典型正常范围改善的儿童行走能量消耗减少，反之亦然。
Objective: To determine the effect of ankle-foot orthoses on walking efficiency and gait in a heterogeneous group of children with cerebral palsy, using barefoot walking as the control condition.Design: A retrospective study.Methods: Barefoot and ankle-foot orthosis data for 172 children with spastic cerebral palsy (mean age 9 years; hemiplegia: 21, diplegia: 97, and quadriplegia: 54) were compared. These data consisted of non-dimensional speed, net nondimensional energy cost of walking (NN-cost), and NN-cost as a percentage of speed-matched controls (NN-cost(pct)). For 80 of these children the Gillette Gait Index and data for 3D gait kinematics and kinetics were also analyzed.Results: Speed was 9% faster (p < 0.001), NN-cost was 6% lower (p=0.007), and NN-cost(pct) was 9% lower (p=0.022) when walking with an ankle-foot orthosis. The Gillette Gait Index remained unchanged (p=0.607). Secondary subgroup analysis for involvement pattern showed a significant improvement in NN-cost(pct) only for quadriplegics (20%, p=0.004), whereas it remained unchanged for patients with hemiplegia and diplegia. Changes in the minimum knee flexion angle in stance phase and in terminal swing were found to be significantly related to the change in NN-cost(pct) (p=0.013 andp=0.022, respectively).Conclusion: The use of an ankle-foot orthosis resulted in a significant decrease in the energy cost of walking of quadriplegic children with cerebral palsy, compared with barefoot walking, whereas it remained unchanged in herniplegic and diplegic children with cerebral palsy. Energy cost reduction was related to both a faster and more efficient walking pattern. The improvements in efficiency were reflected in changes of stance and swing phase knee motion, i.e. those children whose knee flexion angle improved toward the typical normal range demonstrated a decrease in energy cost of walking, and vice versa.